Objective: To evaluate the reliability of subjective diagnoses of benign prostatic obstruction (BPO) using flexible cystourethroscopy as compared to the actual degree of bladder outlet obstruction as measured by a pressure-flow study (PFS), and to investigate the difference of subjective diagnoses among different urologists. Methods: A standardized PFS was done in 33 BPO patients. The degree of BPO (0∼VI) was determined by linear PURR. Flexible cystourethroscopy was also performed in order to evaluate the BPO by video recording. Nine urologists, who have served on the Japanese Board of Urology, diagnosed the degree of the BPO (0∼VI) by watching the video recordings. The degree of obstruction revealed by cystourethroscopy was dependent upon the subjective impression of each urologist who wrote their diagnoses on questionnaires. Results: A positive correlation was found between the results of the PFS and the subjective evaluations based on the cystourethroscopy video (p < 0.001), and the trained urologists arrived at a similar obstruction grade in most cases. However, relatively large gaps between linear PURR and cystoscopic finding were found in some cases. We suggest that these gaps could be caused by dynamic obstructions which cannot be detected by cystourethroscopy. Conclusions: Even though it is difficult to establish an objective measurement of the degree of a BPO using cystourethroscopy, our results show that it is a simple and reliable tool for the assessment of BPO in most cases.

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